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TRAM (Transverse Rectus Abdominus Myocutaneous) Flap

With the TRAM Flap technique, your excess abdominal skin and fat is used to reconstruct the missing breast or replacement of breast tissue. The TRAM can be performed immediately or as a delayed reconstruction.

Types of TRAM Flaps

DIEP or SIEA Flaps
Specialized versions of the free TRAM flap, in which your abdominal tissue is used without using ANY of the rectus muscle. These procedures carry a slightly higher overall risk than the pedicled or free TRAM. However, these flaps have the added benefit of preserving abdominal muscle function and reducing the abdominal bulge rate.

Abdominal tissue is disconnected from underlying muscle and reattached in the breast using microsurgery to reconnect the blood vessels.

  • Less muscle is used in this operation than the pedicled TRAM, thereby maintaining your abdominal strength.
  • This flap has better circulation, allowing more tissue to be transferred, and provides for accurate shaping of the tissues.
  • This type of reconstruction is successful more than 95% of the time.

Pedicled TRAM
Abdominal tissue remains connected to the rectus abdominus muscle and is tunneled under the skin of your upper abdomen into the breast.

  • Removing the rectus muscle may lead to abdominal weakness or bulge formation.
  • This technique is successful in 98 to 99% of cases. Rarely, a portion of the flap may be lost due to inadequate circulation.

The TRAM, DIEP, and SIEA Flaps can be used for reconstruction of both breasts simultaneously. However, once they have been used to reconstruct a single breast they cannot be used again in the future for the other breast.

Reasons for Considering
If you have loss of breast tissue and skin following mastectomy on one or both sides.

Procedure Description
A flap of your lower abdominal fat, muscle (and usually skin), is transferred to the area of missing breast tissue with its own blood supply. In a standard TRAM flap, the blood supply is within the rectus muscle(s), which is left attached to the lower edge of the rib cage.

  • In a Free TRAM, the blood vessels are reconnected to the vessels in the axilla.
  • In a Turbocharged TRAM, the muscle is left attached superiorly, but the inferior vessels are connected in the axilla creating a double blood supply.
  • The abdominal donor site is closed as in a tummy tuck, leaving a horizontal scar and a tighter abdomen.
  • An attempt is made to create a "normal" breast mound and shape at the first operation, but subsequent smaller procedures are frequently necessary.
  • Nipple/areolar reconstruction is performed at a later date.
  • Length of stay: A TRAM Flap Breast Reconstruction is a major procedure performed in the hospital and requiring at least several days of hospitalization.

Recovery Process and Final Result
Discomfort: You will start walking the day after surgery and will be reasonably comfortable within 10 to 14 days. The abdominal area causes the most discomfort during healing

Complete recovery usually takes about 6 weeks.

Other Options For Your Consideration
Additional procedures that may enhance your results are breast enlargement, breast lift, or reduction of the opposite breast and/or nipple (areolar) reconstruction.

Insurance Information
This procedure is usually covered by insurance. You must check with your own insurance company to determine your specific coverage and exclusions.